Tuesday, May 25, 2010

Final exams are at the end of most school semesters, including medical school. So this post is dedicated to the medical students who are hunkered down right now in their study bunkers, preparing for the worst.

At the end of the second year of medical school is the USMLE-1 (United States Medical Licensing Boards, Part 1- the name is misleading, several countries use it). This covers every subject from the first 2 years of medical school: Anatomy, Biochemistry, Pathology, Pharmacology, Microbiology, Neuroanatomy, Physiology, Histology, and a few others. 2 years of learning, all in 1 awful test. When I took it the test consisted of 4 sessions spread out over 2 days. Each session had 200 questions, and 3 hours to answer them.

At my school, if you failed the test, you had to take it again. If you failed it twice, your medical career was over (though you still owed your student loans back).

It was the Summer of 1991.

I don't remember the specific dates. But basically, between the time med school ended for the Summer, and the dreaded test, was roughly 1 month. You had 30 days to re-study everything that had taken you 2 years to learn to that point. And pretty much your chances of a career in medicine depended on how you did.

So it was stressful. And, to this day, I still feel for all of you who are out there studying for it now. Any classmate, resident, or attending who tells you they weren't scared is lying.

Within hours of the semester ending, my class had gone into hiding.

I stopped shaving, to save time. My roommate, Enzyme, disconnected our TV, moved it across the room, and piled furniture in front of it.

My days consisted of me getting up at 7:30 and showering. I'd either stay at my apartment desk or walk over to campus to find an empty classroom to study in. I'd put in my trusty earplugs and the world around me ceased to exist.

Around noon I'd go back to my apartment for a PBJ, then go study again. At 5 I'd go back to my place for a sandwich, or ramen soup, or Rice-a-Roni. I'd sit out on my balcony and eat, for 15 minutes of relaxation. Or I'd read a book with dinner (Enzyme and I were both reading a single copy of "The Price of Admiralty" by John Keegan. It sat on our kitchen table for the month, and we'd have different eating times so we could share it). I never spent more than 30 minutes on a break. After dinner I'd go back to my desk, or campus. I'd study until around 3 a.m., then go home to sleep for a few hours.

I called my parents a few times. My daily outfit consisted of gym shorts (the short kind, from the 80's), T-shirt, sneakers, and the growing beard. Days blended together. There were no differences between weekends and weekdays. People I encountered were superfluous to my existence. I saw my classmates a few times, and we exchanged glassy-eyed nods as we passed.

I shaved a night or two before the test. I studied until around 11:30 p.m. on the eve of the test, re-reviewing a few last points.

It was weird, like I was living alone on another planet for 30 days. I have no idea what happened in the news that month. I was out-of-touch with everything but my books.

If there's one thing I came out of medical school with, it was this: The realization that there was absolutely, positively, no way you were EVER going to get everything read, studied, and reviewed that you needed to before the test.

And, somehow, when the test was over and the dust had settled, you'd done it. And you'd have no idea how. I still don't.

39 comments:

I'm currently in med school in England and planning on doing step 1 in the not-too-distant future. I'm living your pain. I have the extra burden of not being taught the same stuff or tested in the past in the same way.

While I was studying for this hideous round of exams (our med school didn't do the natl boards, being a FLEX state and all, but we had a similar set at the end of basic sciences), a bill collector somehow got my phone number in connection with a deadbeat who didn't pay her department store credit card bill.

They woke me up at all hours, interrupting my precious sleep patterns. I was so strung out by the exam that I was panicked--I didn't know what to do.

It wasn't until the damn things were over that I called my folks for advice. It seems that simply providing a SSN, which had NEVER occurred to me in my sleep deprived state, solved the problem.

Hmm, I'm preparing to do my finals in Australia in November, we have a month to revise 5 years (undergraduate medical degree) of material. Your post has confirmed that it will be as painful as I anticipate :-S

It wasn't nearly so bad when I took it a year and a half ago. My med school has the [my med school] method, which gives us a pretty detailed plan of what we need to review and how much time to spend on each subject. We also don't take our Step 1s until after we do our core clinical rotations since we start those 6 months earlier than most med schools. This helps A LOT. The test itself is now on the computer and consists of 7 60 minute blocks with 48 questions each. You get 60 minutes worth of breaks to be taken when you need them. I think I studied about 7 hours per day on average (not including breaks), but I also had meetings with faculty and went to the gym from time to time. I made sure I slept at least 8 hours per night. I remember thinking how easy studying for the boards was compared with being a core clerkship student.

Sounds worse than the vet licensing exam. We take our exam in either Nov of 3rd year or Apr of 4th year. If you fail in Nov you can retake in Apr and still graduate on time. If you fail in Apr, you have to wait a whole year to take it again. Some students (smart or lucky) have time off right before it to study. Some (like me) are on clinical rotations right up until the day of the test. At my school we got one day off to take the exam as long as we took it in state. If you had to travel to another state to take a separate jurisprudence or medical exam you had to take one of your vacation rotations to do so. Our exam covered pretty much everything, but is biased towards small animal medicine, since that's what the majority of veterinarians in this country do. Kind of sucks for those of us who are equine or food animal inclined. Oh, and they throw in random practice management questions, too. Overall it wasn't too terrible as long as you're a good test taker. Luckily I am, but I know some classmates who aren't good test takers had a more difficult time. Our class did have a 97% first time pass rate though (highest in the country last year!).

I was thinking about this the other day, as it's that time of year for Step 1.

For Step 1, I studied 8-9 hours a day for a solid month. I took my First Aid for Step 1 as a second husband. I refuse to part with my BRS Pathology book because I spent so much time writing in it and reading it I can't bear to part with it.

For Step 2, I studied while traveling around for interviews and while on my adult ICU rotation. I studied less per day but spread it out over six weeks.

For Step 3, I read Crush Step 3 twice. I did some review questions. I maybe spent 3 weeks studying. And I scored 20 points higher on this test than the previous two.

For the peds boards that were in October last year, I started studying in January - a couple hours a night, reading review articles, doing questions and living with Zitelli (a pediatric image atlas from which most of the photos on the test are gleaned). As it got closer I spent more time doing questions.

I like how this time you included the detail about the short shorts. Hahahha.

And also I am glad you posted it because I wont feel so guilty for all those times I wrote someone a great email then thought--damn!! that would make a sweet post (then wondered if the person who received the email would think it was weird).

It does indeed sound worse than NAVLE, e.g. veterinary boards, although when you are a horrible standardized test taker who was voted "Least Likely To Work On A Cow" in your class, the questions starting off with "You are called out to a farm to see a cow ..." made me want to crap my pants. So did "You are asked to investigate a curious group of deaths of geese and ducks in a local pond." A miniscule percentile of that crap is relevant today...and I still have nightmares about swine diarrhea...

This seems quite ironic. I just graduated pharmacy school, and I take the NAPLEX (North American Pharmacist Licensure Examination) today at 3pm. This is our national boards we all must pass. Granted, this is MUCH easier than what you went through, (90% pass rate or so) it's still a stressful time. I have been using Dr Grumpy's blog as a break for the last 2 weeks! I know what it's like for 5 years of school to be condensed into 5 hours of exam.

Us nurses have something similiar called the NCLEX, I am sure that it is no where as hard but it tests everything we leaned in a 2 year period. The catch is that the questions run between 75 to 265 questions. It is a computer test and stops when it has figured out if you know your stuff or if you are complelty brain dead. After a month of attempting to relearn 2 years of things that I hardly use anymore, I took the test and it shut down at 75 questions. I spent 3 days freaked out till I had my passing results.

While touched by your empathy for current students I was especially struck by the visual of 80's short shorts, and since my only picture of you is that handsome fellow in your profile pic I am now picturing him (quite against my will) in 80's short shorts and thank you very much for that, sir.

Good god, you mean the test was actually *less* benign in the past?! We had a "mere" 7 hour computer session for Step 1. June 21st was the longest day of the year in more than one way that year. WV: [tor]turre, appropriately enough

Omg. I don't even get a month; our school gives us barely 3 weeks and if you want any sort of break before 3rd year, it's basically 2 weeks. I'm freaking out right now, of course. And on top of that we're still in finals at the moment. June 14 is coming... Well regardless, it's good to know there have been many before me :p

I'm in nursing school. Thankfully, in every class, the prof will say, "This is a very common question on the NCLEX." It's very helpful. They also give advice such as, if one of the answers is "grapefruit juice," just pick it. As a Ph.D. who obviously can't stay out of school, it's been a very different pedagogical experience. Every class involves a whole new set of material to memorize, and this is a BSN program. I can't even imagine all the hoops docs go through.

"If there's one thing I came out of medical school with, it was this: The realization that there was absolutely, positively, no way you were EVER going to get everything read, studied, and reviewed that you needed to before the test."

A med school professor once told me that one of the tasks of the med school curriculum was to show a class undoubtedly full of people who had never met a challenge they couldn't beat, that they did indeed have limits. Otherwise, they would kill someone.

Like the other vets that have made comments on the NAVLE (our national exam), the hardest part was being able to study while on rotations in our 4th year, which are clinicals. I remember being on large animal overnight ICU duty where we had to do treatments every hour. Some nights we had so many ICU patients that when we got done with one hour treatments, it was time to start the next set. Some nights, I could fit in studying between the treatments.

I think that the year I took the NAVLE was the first time it was on the computer. I liked it that way because you didn't have to wait on everyone else to finish a section, like I used to have to do in other standardized tests.

Of course, the random questions on dolphins or emus or whatever were total BS because the likelihood of that having been covered in school was nil, but you were still expected to "know" the answer.

I don't remember what my score was, but it was not the highest or the minimum. One of my friends was very proud to have passed by a single point because that meant that he didn't over study...lol. He was not exactly type A.

I am in this process now... good to know that other fellow med students are feeling the same way. wake up at 6:30, In the library by 7:15-noon - eat - 12:30-5 - Eat - 6-11. Repeat! life is such a blur right now!21 days till the exam and counting. Its so serial because you want the exam to just be here already do you can take it and move on to rotations.. but you also want all the time in the world to study as much as you possibly can and cram every single little detail in your head that you can. But you are right, you will never know all of it, you aren't suppose to. That thought it somewhat reassuring during this whole process.

what we do is important. and difficult. and requires personal skills that make mastery of the cognitive essential. it helps to pay attention during the first two years, but i am still learning thirty years later, and still enjoy it. and every few weeks i draw upon a memory of something i learned thirty years ago that i may not have seen the use of and did not use in the intervening decades.

I have often heard med school compared to a V in terms of how much you hate your life. Step 1 was definitely the bottom of the V for me. MS2's, it'll be ok, you will all pass and med school will get better from here. In 2 years, you'll be doctors and then the freaking out will really start. I know because I'm living that part now.

Over here in the Netherlands we don't have such a licensing exam in medical school... They've started a national standarized test but not all universities participate in it (mine does) and it's certainly not as difficult as your exams... Should I be happy or not? Sometimes I'm quite jealous at the level of knowledge you US doctors seem to have - we'll never be able to achieve that, I think :(.

Wow, we share some similarities. I read John Keegan's "The Face of Battle" during my medical school second year cram sessions. However, I was more laid back I have to say. I studied in two three-four increments, one in the AM and one in the PM with plenty of guitar playing and screwing around in between. I also went out for a beer every few nights. I stayed up til about 11 the night before and watched TV for the last hour or two to decompress. I crammed for about 30 min before the exam and passed with a "234" - which was pretty good at the time(I have no idea what the scale is these days).

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

Singing Foo!

Have Dr. Grumpy delivered automatically to your Kindle for only 99 cents a month! Sign up here!

Dr. Grumpy is for hire! Need an article written (humorous, medical, or otherwise) or want to commission a genuine Grumpy piece for your newspaper/magazine/toilet paper roll? Contact me to discuss subjects. You can reach me at the email address below, or through my Linked-In profile.

Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.